NEW YORK — The risk of acquiring an infectious disease
while performing cardiopulmonary resuscitation is very low, and can
be further reduced with simple infection-control measures, U.S.
researchers report. Patients who receive CPR within three to four
minutes of going into cardiopulmonary arrest are the most likely to
survive, research findings suggest.

"Unfortunately, fear of contracting a communicable disease,
especially HIV infection, has become a major barrier to immediate
response," Drs. George C. Mejicano and Dennis G. Maki, of the
University of Wisconsin Medical School in Madison, write.

The researchers, who reviewed more than 200 studies
investigating the risk of infection during CPR, summarize their
findings in an article in the Nov. 15 issue of the Annals of
Internal Medicine.

The probability of acquiring a blood-borne virus — such as
the human immunodeficiency virus, hepatitis B virus, or hepatitis C
virus — through exposure to the saliva of an infected patient
during CPR is "extremely low." And the odds of acquiring
cytomegalovirus are "probably not great," the researchers
report.

"No cases of HIV, HBV, HCV, or CMV infection transmitted by
mouth-to-mouth ventilation have been documented," they write. One
study the researchers reviewed estimated the risk of acquiring HIV
during mouth-to-mouth contact at between 1 in one million and one
in 1 billion.

There have been three documented cases in which health workers
appear to have contracted HIV when their skin came in contact with
an infected patient's blood. In each case, however "the exposure
was heavy and prolonged and the exposed healthcare worker had
chapped hands or other possible skin breaks," Mejicano and Maki
write.

The more than 200 studies that the researchers reviewed
documented only one or two instances in which other infectious
agents — such as mycobacterium tuberculosis, Shigella sonnei,
Salmonella infantis, Neisseria gonorrhoeae, and Herpes simplex
virus — were transmitted from patient to rescuer during CPR.
And they found reports of only four instances in which healthcare
workers contracted Neisseria meningitidis, a pathogen that causes
meningitis.

"The scene of a resuscitation is often chaotic, and healthcare
workers engaged in CPR are therefore at risk for exposure to
blood-borne pathogens from accidental needlesticks and other sharps
injuries," Mejicano and Maki note. Even so, their analysis of 25
studies investigating needlesticks and infection suggests that
health workers' risks of acquiring HIV through needlesticks is less
than 1 percent, at 0.32 percent.

The use of mouth barriers, procedures for the safe disposal of
needles and sharps, immunization against hepatitis B, screening and
treatment after exposure to pathogens, and, whenever possible,
needleless emergency care, can further reduce an already low risk
of contracting infection during CPR, the researchers conclude.